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Obesity and nursing homes

By Pamela Tabar, Editor-in-Chief

Obesity in older adults is tied to multiple chronic conditions and increased risk for other things—including the chances of needing skilled nursing care. But down the road, overly obese seniors may find themselves turned away at the door of many nursing homes simply because the facilities don’t have the specialized equipment to care for them.

Obesity fast facts

A person with a body mass index of 30 or higher is considered obese. Most people who weigh 100 pounds or more over their ideal weight or have a BMI of 40 or higher are considered morbidly obese.

Obesity affects different resident populations differently, but it all adds up to extra cost and higher health risks.

Among all adult ages, non-Hispanic blacks have the highest age-adjusted rates of obesity (47.8%) followed by Hispanics (42.5%), non-Hispanic whites (32.6%) and non-Hispanic Asians (10.8%).

In a recent study of 360 nursing home respondents in Arkansas and Pennsylvania, two-thirds of respondents said that morbid obesity is an admissions barrier at their facilities, although only about 6 percent reported refusing potential residents outright for this reason. The study, published in the Journal of Applied Gerontology, noted that lack of staff and bariatric equipment also negatively impacted the ability to care for obese individuals during care transitions, often leaving such individuals “stranded in hospitals.”

It’s not personal, safety experts say—it’s mechanical. The Occupational Health and Safety Administration (OSHA) has issued rules about lifting limits, including when and how mechanical lifts are needed, and what types of equipment are needed to move residents. Even with the OSHA restrictions, healthcare workers are consistently among the highest affected group when it comes to lifting-related injuries on the job.

Residents who weigh 325 pounds or more often require bariatric equipment and specialized accommodations, including reinforced beds and custom-sized seating. Excessively obese adults also can require completely different bathing facilities, including reinforced flooring to support the water weight in oversized tubs and mechanical lifts to ensure safe bathing transfers.

As the numbers of obese and morbidly obese adults continues to grow—35 percent of U.S. adults over age 60 are now considered obese—long-term care communities will see a growing need to invest in more equipment and furniture designed for this resident population.

"The population is shifting faster than the ability of nursing homes to deal with them," Cheryl Phillips, senior vice president of LeadingAge, said in a New York Timesarticle. "We don’t have adequate staff. We don’t have adequate equipment. We don’t have adequate knowledge."

Little research has focused on obesity in the nursing home setting, leaving a dearth of information on what is needed now and in the future, note the authors of another recent survey published in Research in Gerontological Nursing journal.

How rotund is your region?

The middle of the United States seems to have plenty around its middle, according to this 2014 map from Centers for Disease Control & Prevention. States with the highest percentage of obese adults are Arkansas, Mississippi and West Virginia, but much of the Midwest and South fall into the second-highest tier. States on the East and West Coast tend to maintain healthier body mass indices overall.